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Acute hospital at home – an integrated, holistic and multidisciplinary service

Will Divall, James Richards, Patricia McCormack, Sue Trim and Katie Whitlock
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DOI: https://doi.org/10.7861/futurehosp.6-1-s92
Future Healthc J March 2019
Will Divall
Dorset County Hospital Foundation Trust, Dorchester, United Kingdom
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James Richards
Dorset County Hospital Foundation Trust, Dorchester, United Kingdom
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Patricia McCormack
Dorset County Hospital Foundation Trust, Dorchester, United Kingdom
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Sue Trim
Dorset County Hospital Foundation Trust, Dorchester, United Kingdom
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Katie Whitlock
Dorset County Hospital Foundation Trust, Dorchester, United Kingdom
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Aims

To assess the impact, effectiveness and ongoing development of an acute hospital at home (AH@H) service, created in January 2014.

Methods

Retrospective review of AH@H patients between January 2014 and September 2017 specifically focusing on patient satisfaction, inpatient hospital bed days saved, main conditions treated and re-admission rates. Of discharge to assess (D2A) patients between April 2016 and September 2017 focusing on bed days saved, reduction of care needs and regained independence.

Results

AH@H is a virtual inpatient ward run by a multidisciplinary team, who provide aspects of inpatient care to people in their own homes. Services provided include:

  • intravenous antibiotics (including administration via Surefuser pump)

  • facility to insert and manage PICC/mid-lines.

  • consultant-led daily virtual ward round

  • twice weekly review by senior house officer doctor at home

  • nursing assessments and observations (recorded electronically at the patient’s home, through VitalPac)

  • complex wound care, including VAC pump dressings

  • blood tests

  • physiotherapy, occupational therapy, speech and language therapy and dietitian input

  • coordination with ambulatory care to arrange specialist reviews, further tests or imaging.

Since 2016 a D2A service has been developed that bridges care packages while giving multidisciplinary therapy input.

The AH@H service treats patients with a variety of medical and surgical conditions, the most common are:

  • respiratory infections- exacerbations of bronchiectasis/COPD/asthma and pneumonia (17%)

  • cellulitis (14%)

  • venous thromboembolism (5%)

  • septic arthritis (4%)

  • infected diabetic foot ulcers (4%).

Between January 2014 and September 2017, 1,433 patients have been managed through the AH@H service, saving on average 9.64 bed days per day, with a re-admission rate of only 4.75%. A key success is the high degree of patient satisfaction: 98.13% of patients were ‘likely or extremely likely to recommend the service’ in the Friends and Family Test, compared with 83% on an inpatient ward. Patients feel they recover much better in their own home, eating their normal diet and being able to rest in a more relaxing environment without the disturbances of a busy inpatient ward. The average cost per day of an AH@H is £100, compared with £280 for an inpatient ward bed.

Between April 2016 and September 2017, D2A has managed 379 patients, saving on average 5.58 hospital bed days per day, while reducing 28.5% of patient’s care needs and 21.11% regaining independence, no longer requiring a package of care.

Conclusion

AH@H has been a success and the service has grown with the addition of D2A and increased junior medical cover. The key successes.

  1. An average of 15.22 bed days saved per day.

  2. High patient satisfaction – 98.13%.

  3. On average saving £180 per patient per day, compared with inpatient care.

  4. 49.6% of D2A patients regaining independence and having reduced care needs.

  5. Being adaptable to a variety of medical and surgical conditions to assist patient flow through the hospital.

Conflict of interest statement

None

  • © Royal College of Physicians 2019. All rights reserved.
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Acute hospital at home – an integrated, holistic and multidisciplinary service
Will Divall, James Richards, Patricia McCormack, Sue Trim, Katie Whitlock
Future Healthc J Mar 2019, 6 (Suppl 1) 92; DOI: 10.7861/futurehosp.6-1-s92

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Acute hospital at home – an integrated, holistic and multidisciplinary service
Will Divall, James Richards, Patricia McCormack, Sue Trim, Katie Whitlock
Future Healthc J Mar 2019, 6 (Suppl 1) 92; DOI: 10.7861/futurehosp.6-1-s92
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